Citation Nr: 21067222 Decision Date: 11/03/21 Archive Date: 11/03/21 DOCKET NO. 17-56 628 DATE: November 3, 2021 REMANDED Entitlement to service connection for restless leg syndrome, to include as secondary to the service-connected bilateral carpal tunnel syndrome, is remanded. Entitlement to service connection for sinusitis is remanded. Entitlement to service connection for rhinitis is remanded. REASONS FOR REMAND The Veteran had active military service from August 1974 to December 1980. He testified before the undersigned Veterans Law Judge during a July 2020 hearing. This matter is on appeal from a January 2015 rating decision and was previously remanded by the Board of Veterans' Appeals (Board) in January and June 2021. Unfortunately, there has not been substantial compliance with the Board's previous remand directives regarding all issues. Another remand is required. Stegall v. West, 11 Vet. App. 268, 271 (1998). 1. Entitlement to service connection for restless leg syndrome, to include as secondary to the service-connected bilateral carpal tunnel syndrome, is remanded. The Board cannot make a fully-informed decision on the issue of service connection for restless leg syndrome because no VA examiner has opined whether it is aggravated by the service-connected bilateral carpal tunnel syndrome. The Board remanded this issue in June 2021 to obtain such opinion. The opinion obtained in July 2021 again considered whether restless leg syndrome is proximately due to bilateral carpal tunnel syndrome, but did not address aggravation. A remand for a new opinion is necessary. 2. Entitlement to service connection for sinusitis is remanded. 3. Entitlement to service connection for rhinitis is remanded. The Board cannot make a fully-informed decision on the issues of service connection for sinusitis and rhinitis because no VA examiner has provided an opinion considering the Veteran's testimony of ongoing symptoms since service. The Board remanded this issue in June 2021 to obtain such opinion. The opinion obtained in July 2021 again did consider Veteran's testimony of ongoing symptoms since service. Additionally, this opinion indicates that the Veteran's rhinitis preexisted service, and was less likely as not aggravated by service. This opinion did not use the clear and unmistakable standard that applies to preexisting disorders, and is not adequate. A remand for a new opinion is necessary. The matters are REMANDED for the following action: 1. Obtain a medical opinion from a medical professional with appropriate expertise to determine the etiology of the diagnosed restless leg syndrome. The examiner is requested to review the record and offer an opinion as to whether it is at least as likely as not (at least an approximate balance of positive and negative evidence) that the diagnosed restless leg syndrome is AGGRAVATED by the service-connected bilateral carpal tunnel syndrome. (If restless leg syndrome is found to have been aggravated by the service-connected bilateral carpal tunnel syndrome, the examiner should quantify the approximate degree of aggravation.) The examiner must consider the private September 2018 medical opinion that secondary causes of restless leg syndrome include peripheral neuropathy such as carpal tunnel syndrome. A complete rationale must be given for all opinions and conclusions expressed. 2. Obtain an addendum medical opinion from a medical professional with appropriate expertise to determine the etiology of the diagnosed chronic sinusitis and allergic rhinitis. The examiner is requested to review the record and offer opinions as the following: (a.) Is there clear and unmistakable evidence (obvious, manifest, and undebatable) that the currently diagnosed allergic rhinitis preexisted the Veteran's active service (August 1974 to December 1980)? (b.) If so, state whether there is clear and unmistakable evidence that the preexisting allergic rhinitis was NOT aggravated (i.e., permanently worsened) during service; or whether, it is clear and unmistakable that any increase in service was due to the natural progress of the disorder. (c.) If allergic rhinitis is NOT found to clearly and unmistakably exist prior to service, whether it is at least as likely as not (at least an approximate balance of positive and negative evidence) that the diagnosed allergic rhinitis had its onset in or is due to service. (d.) Whether it is at least as likely as not (at least an approximate balance of positive and negative evidence) that the diagnosed chronic sinusitis had its onset in or is due to service. In addressing whether allergic rhinitis clearly and unmistakably preexisted service, the examiner should consider the Veteran's May 1974 enlistment examination showing a clinically normal nose and sinuses, and the enlistment report of medical history showing "yes" to hay fever. The examiner must consider the Veteran's July 2020 testimony regarding ongoing sinusitis and rhinitis symptoms since service. A complete rationale must be given for all opinions and conclusions expressed. A. C. MACKENZIE Veterans Law Judge Board of Veterans' Appeals Attorney for the Board L. Barstow, Counsel The Board's decision in this case is binding only with respect to the instant matter decided. This decision is not precedential and does not establish VA policies or interpretations of general applicability. 38 C.F.R. § 20.1303.